Technetium-99m (Tc-99m) thyroid scintigraphy is a well known diagnostic tool that shows the entire gland in a single image. We aimed to evaluate its additive diagnostic value in subclinical autoimmune thyroid disease (S-AITD) in systemic lupus erythematosus (SLE) patients.
Methods
We investigated 100 systemic lupus erythematosus (SLE) patients without overt thyroid involvement (eight men and 92 women; mean age 40±6.5 years) and 50 age and sex matched controls. All were subjected to thyroid evaluation using anti-thyroglobulin (anti-TG) and anti-thyroid peroxidase (anti-TPO) antibodies; hormones (FT3; FT4 and TSH) and Tc-99m thyroid scintigraphy.
Results
14/100 (14%) and none (0%) were positive for S-AITD in SLE and control groups, respectively (P = 0.0001). They were classified by thyroid scintigraphy and hormonal profile into 2/14 Hashimoto; 10/14 atrophic thyroiditis and 2/14 Graves' disease. Anti-TPO was elevated in 12 SLE cases, while anti-TG was elevated in only 2/14 (P = 0.0001). Thyroid scintigraphy showed statistically significant associations with FT4, TSH and anti-TPO.
Conclusion
Tc-99m thyroid scintigraphy may have an additional diagnostic role in S-AITD among SLE patients, with an impact on patient management. This potential needs to be further evaluated in a larger series on a multicenter basis.
PyneDIsenbergDA. Autoimmune thyroid disease in systemic lupus erythematosus. Ann Rheum Dis2002; 61: 70–72.
2.
DayanCMDanielsGH. Chronic autoimmune thyroiditis. N Engl J Med1996; 335: 99–107.
3.
HelvaciMROzcuraFOzkanADayiogluH. What a high prevalence of autoimmune thyroiditis and thyroidectomy in women. J Med Sci2006; 6: 654–657.
4.
PorkodiRRameshSMaheshAKanakaraniPRukmangathrajanSRanjendranPC. Thyroid dysfunction in systemic lupus erythematosus and rheumatoid. J Indian Rheumatol Assoc2004; 12: 88–90.
5.
ZakeriZSandooghiM. Thyroid disorder in systemic lupus erythematosus patients in Southeast Iran. Shiraz E-Med J2010; 11: 1.
MousaAAGhonenMHegazyABaiomyAADiastyA. Thyroid function and autoantibodies in Egyptian patients with systemic lupus erythematosus and rheumatoid arthritis. Trends Med Res2012; 7: 25–33.
8.
AssalHSElSherbinyAAlsayedAMaaboudMAAlShabrawiHRasheedE. Thyroid dysfunction in patients with systemic connective tissue disease. Maced J Med Sci2009; 2: 223–229.
9.
MillerFWMooreGFWeintraubBDSteinbergADBurmanKD. Thyroid stimulating and thyrotropin binding-inhibitory immunoglobulin activity in patients with systemic lupus erythematosus having thyroid function abnormalities. Thyroid1993; 1: 229–234.
10.
EberhsadBALaxerRMEddyAASilvermanED. Presence of thyroid abnormalities in children with systemic lupus erythematosus. J Pediatr1991; 119: 277–279.
11.
Hijmans W, Doniach D, Roitt IM, Holborow EJ. Serological overlap between lupus erythematosus, rheumatoid arthritis, and thyroid auto-immune disease. Br Med J1961; 2: 909–914.
12.
ScofieldRH. Autoimmune thyroid disease in systemic lupus erythematosus and Sjögren’s syndrome. Clin Exp Rheumatol1996; 14: 321–330.
13.
RodriqueSLabordeHCatoggioPM. Systemic lupus erythematosus and thyrotoxicosis: a hitherto little recognized association. Ann Rheum Dis1989; 48: 424–427.
HochbergMC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1997; 40: 1725.
16.
ElgazzarAH. Thyroid gland in the pathophysiologic basis of nuclear medicine, 2nd ed. Berlin: Springer, 2006, pp. 209–221.
17.
EschlerDCHashamATomerY. Cutting edge: the etiology of autoimmune thyroid diseases. Clin Rev Allergy Immunol2011; 41: 190–197.
18.
TomerY1HuberA. The etiology of autoimmune thyroid disease: a story of genes and environment. J Autoimmun2009; 32: 231–239.
BastianHM1AlarcónGSRosemanJM. LUMINA Study Group. Systemic lupus erythematosus in a multiethnic US cohort (LUMINA) XL II: factors predictive of new or worsening proteinuria. Rheumatology (Oxford)2007; 46: 683–689.
26.
LawindMF1AlyaskyAElwanNMMouradHAl-BendaryA. Alpha-fodrin autoantibodies are reliable diagnostic markers for juvenile and adult Sjögren’s syndrome. Egypt J Immunol2004; 11: 75–81.
27.
ParkDJChoCSLeeSH. Thyroid disorders in Korean patients with systemic lupus erythematosus. Scand J Rheumatol1995; 24: 13–17.
28.
ByronMAMowatAG. Thyroid disorders in systemic lupus erythematosus. Ann Rheum Dis1987; 46: 174–175.
29.
WeetmanAPWalportMJ. The association of autoimmune thyroiditis with systemic lupus erythematosus. Br J Rheumatol1987; 26: 359–361.
30.
TsaiRTChangTCWangCRChuangCYChenCY. Thyroid disorders in Chinese patients with systemic lupus erythematosus. Rheumatol Int1993; 13: 9–13.
31.
BoeyMLFongPHLeeJSCNgWYThaiAC. Autoimmune thyroid disease in SLE in Singapore. Lupus1993; 2: 51–54.
32.
EberhadBALaxerRMEddyAASilvermanED. Presence of thyroid abnormalities in children with systemic lupus erythematosus. J Pediatr1991; 119: 277–279.
33.
MillerFWMooreGFWeintraubBDSteinbergAD. Prevalence of thyroid disease and abnormal thyroid function test results in patients with systemic lupus erythematosus. Arthritis Rheum1987; 30: 1124–1131.
34.
KohnoYNaitoNSaitoK. Anti-thyroid peroxidase antibody in sera of patients with systemic lupus erythematosus. Clin Exp Immunol1989; 75: 217–221.
35.
RodriqueSLabordeHCatoggioPM. Systemic lupus erythematosus and thyrotoxicosis: a hitherto little recognised association. Ann Rheum Dis1989; 48: 424–427.
36.
GohKLWangF. Thyroid disorders in systemic lupus erythematosus. Ann Rheum Dis1986; 45: 579–583.
37.
FatourechiVMcConaheyWWoolnerLB. Hyperthyroidism associated with histologic Hashimoto's thyroiditis. Mayo Clin Proc1971; 46: 682–689.
38.
TamaiHNakagawaTOhsakoN. Changes in thyroid functions in patients with euthyroid Graves' disease. J Clin Endocrinol Metab1980; 50: 108–112.
